Factors Affecting Payment Compliance of the Indonesia National Health Insurance Participants

Background

The study aims to explore factors that affect the compliance of Indonesia National Health Insurance (INHI) in paying the premiums.

Methods

The study design was qualitative with grounded theory research approach and constructivism paradigm. The study was conducted in 2018 and carried out for 3 months. We recruited 22 respondents from four different cities/districts. Triangulation was carried out through 26 informants from various stakeholders. Data were analyzed through coding, categorizing and pattern matching to obtain substantive theory.

Results

The resulting substantive theory consists of 6 constructs and 14 categories. Compliance with paying insurance premium depends on the intention to pay for contribution. Meanwhile, the intention to pay is related to internal and external factors of INHI participants. To improve payment contribution of independent participants, INHI program has to pay attention for factors originating internally from the participants themselves (understanding of INHI program, financial ability and self-attitude) and also externally such as operational system and the quality of health care.

Conclusion

Compliance of paying insurance premium is related to internal and external factors of participants. Thus, interventions to improve compliance to pay premium should take these factors into account, and not merely on increasing the knowledge of participants.

Determinant of Highschool Girl Adolescent' Adherence to Consume Iron Folic Acid Supplementation in Kota Depok

Anemia is one of the major problems among female adolescents in Indonesia. Weekly iron-folic acid supplementation was a cost-effective measure to tackle adolescent anemia. However, adherence to the supplementation is low. This study was aimed to explore the determinants of t highschool females' adherence to consume iron-folic acid tablets. Using cross sectional design with 274 subjects. After obtaining consent the data were collected, coded and analysed using SPSS23. The inclusion criteria were high school female from 18 schools which had iron tablets program. The majority of subjects was 14-16 y old (73.7%). The majority of schools gave iron tablets to students without organizing taking iron tablets together (63.5%). The adherence to consume iron and folic acid tablets in this study was 45.6% (n=125). Almost half of highschool female (36.1%) cited they did not think that iron tablets are necessary while 12.4% cited experiencing side effects. Factors that were correlated (p<0.005) were school organizing taking iron tablets together, the student's age, knowledge, motivation, self efficacy, prior Hb level examination, and teacher educating the benefits of iron tablets to students (OR=9.5, CI=5.4-16.8, OR=0.43, CI=0.23-0.78, OR=2.12, CI=1.29-3.48, OR=6.55, CI=3.77-11.4, OR=6.39, CI=3.7-10.9 respectively). The most important factors which determined highschool female's adherence were school organizing students to take iron tablets together at school (OR=7.2, CI=3.5-14.6, p=0.000), student's motivation (OR=5.3, CI=2.5-11.3, p=0.000), and class teacher educating students on anemia and IFA (OR=2.3, CI=1.2-4.6) meanwhile student's knowledge, self efficacy, and prior Hb level examinations were confounding factor.

School Readiness in Weekly Iron Folic Acid Supplementation Program in Urban Area, West Java, Indonesia

Background:School based weekly iron and folic acid supplementation (WIFAS)  program was aimed to decrease anemia prevalence and improve the adherence to consume iron tablet.Limited information on the school perspective and their readiness to implement the program.Objectives:To analyze program guidelines, stakeholders’ perspective and school readiness to implement the program which will help evaluate and improve adherence to WIFAS.Methods:Using cross sectional design with mixed method approach to utilize social ecological model and community readiness model.Results: Most of schools received awareness campaign regarding the program,only 38,9% have conducted a drinking together session once a week,only 27,8%  recorded their students’ adherence.The average score for the school readiness was 3.36 (SD ±0.82), the school was in the vague awareness stage.There is  a  correlation between the score of school’s knowledge, attitude toward WIFAS program,City Health Authority and Education Regional Office ‘s support score, the total score of the school readiness, ever got socialization with implementation of WIFAS (r= 0.35, r=0.2, r=0.49, r=0.21, r= 0.66, r= 0.43, p value <0.005).The strongest correlation with implementation of WIFAS at school was the school readiness total score, ever received  socialization and score school’s knowledge on WIFAS (p value <0.005) and City health Authority and Education regional office’s support score for WIFAS program as covariant  (p >0.05).Conclusions: School readiness is important factor of community and environment which contribute to behavior change.School realize that anemia and schoolgirl adherence to consume WIFAS had to solved but did not know how and assume outside parties can help solve the problem.The City Health Authority and Education Regional Office is expected to help improve the school readiness to implement the program.